Ultrasonographic study of comparison of prostate volume and post void residual urine with age in north Indian population

Background: As men’s life expectancy increases, benign prostatic hyperplasia (BPH) is the significant cause of morbidity. BPH generally involves the central region of the prostate which gradually enlarges. Due to the central hypertrophic change of prostate the urethra is compressed and urinary outflow obstruction develops. Predictive risk factors associated with chance of developing urinary retention includes age, symptoms, urinary flow rate and prostate size. Estimation of accurate intravesical, residual urine has significant importance and serves as an index of adequacy of bladder emptying. Aims and Objectives: The study aimed to measure the post void residual urine volume with age in Prostate outflow obstruction and compare the prostate volume and post void residual urine with age by ultrasonography. Materials and Methods: The present study was performed in 100 patients. Transrectal ultrasonography was performed using 7.5 MHZ transrectal probe. Prostate volume was calculated with the help of inbuilt software, by measuring 3 dimensions of prostate in transverse and longitudinal sections. Transabdominal suprapubic ultrasound was done to measure post void residual urine. Results: It was seen that in the lower age groups, the prostate size was smaller, while in the higher age group it was higher (p>0.001). Minimum post void residual urine was seen in age group of 40-49 years (3.42 -+2.23ml). while maximum mean value was seen in the 70-79 years of age. Statistically a significant difference in mean was seen among different age groups (p<0.001). Conclusion: There is a significant correlation between age and post void residual urine volume and prostatic volume. The present study showed that PVRUV is a novel accurate non-invasive test for predicting prostate biopsyoutcome that can easily be used by clinicians, alone or in combination with Prostate Volume in the decision-making for treatment.

Urodynamic Values Role For Females With Different Types Of Urinary Incontinence

Aim — The aim of this study was to analyse how conventional urodynamic values differ between females with specific types of urinary incontinence (UI). Material and Methods — Cross-sectional study enrolled 666 females with UI. Based on patient history and questionnaires they were divided into three groups: stress (SUI), mixed (MixUI) and urgency (UUI). Physical investigation and urodynamics were performed. The continuous factors: age and urodynamic data were evaluated using Multinomial regression and ANOVA test using SUI, MixUI, UUI as outcome groups. Results — Analysing urodynamic parameters significant difference between at least two groups was shown by the cystometric capacity and maximum flow rate: both highest in the SUI group; residual urine, opening detrusor pressure, maximum urethral closure pressure at rest, functional urethral length at rest: all highest in the UUI group. Mainly all urodynamic data showed significant difference between SUI/UUI, and MixUI/UUI groups, while difference between SUI/MixUI were not significant. Conclusions — Most of urodynamic data for MixUI group patients do not differ from SUI group. UDS parameters like: maximum flow rate, residual urine, opening detrusor pressure, maximum urethral closure pressure at rest, functional urethral length at rest can help to distinguish SUI and MixUI groups from UUI group.

Adipose-derived stem cell-derived microvesicles prevent progression to bladder underactivity secondary to long-termed bilateral partial iliac arterial occlusion-induced bladder ischemia

Background The therapeutic effects of adipose-derived stem cells (ADSCs) and ADSC-derived microvesicles (MVs) were investigated in a rat model of bladder ischemia involving long-term (4 weeks) bilateral partial iliac arterial occlusion (BPAO). Methods The study included four groups: sham, BPAO, BPAO + ADSCs, and BPAO + ADSC-derived MVs. ADSCs or ADSC-derived MVs were injected through the femoral artery. Real-time laser speckle contrast imaging evaluated bladder microcirculation following BPAO. A 24-h behavior study and transcystometrogram were conducted after 4 weeks. Bladder histology, immunostaining, and lipid peroxidation assays were performed. The expression of P2X2, P2X3, M2, and M3 receptors, nerve growth factor (NGF), and collagen-1 was evaluated. Results BPAO for 4 weeks significantly reduced bladder microcirculation, prolonged the intercontraction interval, decreased voiding volume, increased residual urine volume, lengthened phase 1 contraction, shortened phase 2 contraction, increased neutrophil infiltration, increased malondialdehyde levels, and altered levels of P2X3 receptors. ADSC-derived MVs significantly ameliorated these effects, increased NGF expression, and decreased collagen-1 expression. ADSCs only improved voiding volume and increased residual urine volume. Conclusions ADSC-derived MVs prevented adverse consequences of long-term BPAO, including detrusor underactivity, bladder ischemia, and oxidative stress. Amelioration of inflammation, altered purinergic signaling, neuronal regeneration, and decreased fibrosis might be involved in the therapeutic mechanism.

Homoeopathic treatment for lower urinary tract symptoms in men with benign prostatic hyperplasia: an open randomized multicentric placebo controlled clinical trial

Background: Benign Prostatic Hyperplasia (BPH) associated with Lower Urinary Tract Symptoms (LUTS) is the most common condition in ageing men. The epidemiological studies estimate that 90% of men between 45 and 80 years of age suffer some type of LUTS.1 There is paucity of such epidemiological data from India but one study reports the prevalence of BPH among rural elderly of India as 11.8%2. Although LUTS secondary to BPH (LUTS/BPH) is not often a life-threatening condition, the impact of LUTS/BPH and its complications on Quality of Life (QoL) can be significant and should not be underestimated.3 When the effect of BPH-associated LUTS on QoL was studied in a number of community-based populations, for many, the most important motivations for seeking treatment were the severity and the degree of bother associated with the symptoms.4LUTS include storage and/or voiding disturbances common in ageing men. Although voiding symptoms are most common, storage symptoms responsible for daytime frequency, urgency and nocturia interfere the most with life activities. Homoeopathic constitutional treatment is useful in the treatment of a constellation of symptoms due to BPH and LUTS. Along with constitutional medicine homoeopathic practitioners are using organ medicines having special affinity for prostate and urinary bladder with good results. Traditionally the primary goal of treatment is to alleviate bothersome LUTS that result from prostatic enlargement. The literature review indicates that both homoeopathic constitutional medicines as well as organ specific remedies show positive results in relieving the symptoms of BPH but the study was not randomized and there was no control group to show its efficacy. In this backdrop the present study was undertaken to evaluate the storage and voiding symptoms of men having BPH through an internationally validated scale IPSS and the role of homoeopathic intervention, both constitutional and organ remedies on LUTS due to BPH and QoL of the patient. Objectives: The primary objective was to compare the changes in IPSS (International Prostate Symptom Score) within the three groups enrolled for the study (Constitutional remedy/Constitutional + Organ remedy/Placebo). The secondary objectives were to compare the changes in Prostate volume, Post Void Residual Urine (PVRU), Uroflowmetry and in WHOQOL-BREF.5 Material and Methods: The study was done in an open randomized placebo controlled setting at five research centers under Central Council for Research in Homoeopathy. The patients in the age group of 50-80 years presenting with the symptoms of incomplete emptying, frequency, intermittency, urgency, weak stream, straining and nocturia were screened from the general OPD as per ICD-10 Classification Code N40.0 following the predefined inclusion and exclusion criteria. A consultant Urologist was appointed at each center to screen and follow up the enrolled cases. The participants who qualified the inclusion criteria were enrolled in the study after obtaining the ‘Informed Written Consent’. It was a three armed randomized clinical trial where Intervention was administered as per the randomization chart for three groups i.e. homoeopathic constitutional medicine in LM potency (Group 1), homoeopathic constitutional medicine in LM potency with organ remedy in mother tincture and 3X (Group 2) and placebo (Group 3) in 2:2:1 ratio. The patients were followed for six months and the outcome of intervention was assessed monthly for IPSS (Primary objective) and at third and sixth month for prostate volume, post void residual urine, Qmax and Qavg, PSA and WHOQOL-BREF, (Secondary objectives). Internationally validated scales (IPSS &WHOQOL-BREF) were used to assess the outcome. Primary safety endpoint was any adverse event which may be life threatening, requires prolonged hospital stay, results in significant disability, an injury, accident or any other important medical event. 474 patients were screened and 252 patients were enrolled in the study. The analysis of these patients as per protocol and as per intention to treat was carried out using repeated measures ANOVA and paired T test. Results: Out of 254 patients enrolled in the study (HC=103, HC + O = 102 and Placebo = 49), 152 were analyzed as per protocol (HC=71, HC + O = 53 and Placebo = 28) as they completed a follow up period of 6 months whereas, 241 patients were analyzed as per ITT (HC=101, HC + O = 92 and Placebo = 48). 13 patients were excluded from analysis for reasons such as protocol violation and incomplete baseline information. There was statistically significant improvement in all the seven components of IPSS, WHOQOL- BREF and Q max values of uroflowmetry in both per protocol as well as ITT analysis. Discussion: Results from this trial will help in constructing treatment strategy for BPH patients with lower urinary tract symptoms to enable them to make an informed decision about available alternatives for the management of LUTS in BPH. The limitation of the study was that it was not blinded. The inhibition for not making it blinded was the use of mother tinctures of organ specific medicines in liquids of different colors and odours which could not be blinded. Pragmatic trial with longer follow up and a parallel arm comprising of conventional treatment may be undertaken in future to compare their role on LUTS due to BPH on pathological and pathophysiological parameters such as prostatic volume and post void residual urine. Trial Registration: Clinical Trial Registry - India: CTRI/2012/05/002649.

Treatment of overactive bladder symptoms in women with Diunorm®: preliminary results report

Introduction. Overactive bladder (OAB) with or without urgent incontinence tends to progress with age and occurs in both men and women. However, the frequency of occurrence in the female population averages about 25%.Purpose of the study. To assess the effectiveness and safety of the drug Diunorm® (in caps.) in the prevention and treatment of OAB in women.Materials and methods. The statistical analysis includes the results of a survey of 28 women with symptoms of OAB, whose average age was 35.3 years. The drug Diunorm® was used for treatment in dosage 400 mg QD for 90 days. Patients completed the Overactive Bladder Awareness Tool and a urination diary. Additionally, urinalysis, bacteriological examination of urine, uroflowmetry, bladder ultrasound and cystoscopy were performed.Results. All women throughout the study had negative urine cultures and no pyuria in urinalysis, which excluded an infectious etiology of urinary dysfunction. During therapy, a statistically significant decrease in irritative symptoms was recorded according to the Overactive Bladder Awareness Tool questionnaire. The sum of points after 1 and 3 mo decreased by 3.0 and 4.3 points, respectively (p < 0.05). Positive dynamics in terms of the points' sum was noted in 75%, in relation to nocturia in 82% of patients (p < 0.01). The average urination rate increased from 13.3 ± 0.7 ml/s to 15.1 ± 0.7 ml/s and 15.4 ± 0.5 ml/s after 1.5 and 3 months, respectively (p < 0,0001). A similar trend was observed for maximum urine flow and residual urine volume. The maximum urine flow when taking Diunorm® increased from 15.9 ± 0.6 ml/s to 17.4 ± 0.5 ml/s and 18.1 ± 0.4 ml/s (p < 0.001). Residual urine volume decreased throughout the study. When included in the study, after 1,5 and 3 mo, this indicator was 19.9 ± 1.4; 12.2 ± 1.6 and 6.4 ± 1.1 ml, respectively (p < 0.001).Conclusion. Diunorm® can become a worthy alternative to traditional first-line OAB therapy. Comparative studies are required to obtain a high-level evidence base.

Temporary urethral stent with perineal fixation for posterior urethral stenosis (preliminary results)

Introduction. Urethroplasty is the “gold standard” treatment of urethral stenosis. However, often in connection with old and senile age, as well as due to the presence of concomitant diseases, it is not possible to carry out urethroplasty due to its certain invasiveness. In such cases, one of the methods of treatment is the installation of a urethral stent. But this method has not found practical application due to the frequent migration of stent and the high frequency of its incrustation. The approach developed by us avoids stent migration.Purpose of the study. To evaluate the immediate results of the placement of a urethral stent with fixation through the perineum.Materials and methods. A total of 18 patients with urethral stenosis aged 68 to 84 years have been operated on since February 2019. Ten patients had stenosis of the urethrocystoneoanastomosis after radical prostatectomy, 6 patients had iatrogenic stenosis of the prostatic urethra, 1 patient had post-radiation stenosis of the bulbo-membranous urethra. All patients in the preoperative and postoperative periods underwent: IPSS-QoL questioning, uroflowmetry, bladder ultrasound with residual urine volume evaluation, urethroscopy, ascending and micturition urethrocystography. The first stage was an internal optical urethrotomy according to the standard technique. Then, a urethral stent was installed in the area of dissected stenosis. The second stage was an incision in the perineum, the urethra was isolated, and under optical control, through the perineum, the stent was fixed to the urethra with non-absorbable suture material. The stent was removed endoscopically after 6 months.Results. The median surgery duration averaged 45 minutes. Patients were discharged 2 to 3 days after surgery. The maximum observation period was 20 months. During the observation period, not a single case of stent migration was recorded. All patients showed a persistent increase in Qmax and no residual urine. Six patients had a stress component of urinary incontinence, 4 patients had total urinary incontinence. According to control urethrocystoscopy 6 months after stent removal, clinically insignificant urethral stenosis was noted in all patients. In all cases, moderate signs of stent encrustation were identified. Dysuric phenomena disturbed 5 patients, who were stopped by rectal suppositories with NSAIDs, as well as taking herbal uroseptics. The data from the IPPS-QoL questionnaires confirm the positive effect of the treatment.Conclusions. Temporary placement of a urethral stent for urethral stenosis is an effective minimally invasive treatment. The technique of fixation through the perineum allows preventing migration in all cases. This approach to treatment significantly improves the quality of life of patients who were contraindicated for urethroplasty for one reason or another. However, the technique requires longer observation and analysis.

Intrapartum pudendal nerve block analgesia and risk of postpartum urinary retention: a cohort study

Introduction and hypothesis Pudendal nerve block analgesia (PNB) is used as pain relief in the final stage of childbirth. We hypothesized that PNB is associated with higher rates of postpartum urinary retention. Methods We performed a cohort study among primiparous women with a singleton, cephalic vaginal birth at Oslo University Hospital, Norway. Women receiving PNB were included in the exposed group, while the subsequent woman giving birth without PNB was included in the unexposed group. We compared the likelihood of postpartum urinary retention, defined as catheterization within 3 h after birth. Logistic regression analysis stratified by mode of delivery was performed adjusting for epidural analgesia, episiotomy and birth unit. Results Of the 1007 included women, 499 were exposed to PNB and 508 were unexposed. In adjusted analyses, women exposed to PNB did not differ in likelihood of postpartum urinary retention compared to women unexposed to PNB in either spontaneous (odds ratio[OR]: 0.82, 95% confidence interval [CI] 0.55–1.22) or instrumental (OR 1.45, 95% CI 0.89–2.39) births. Furthermore, no differences between the groups were observed with excessive residual urine volume or catheterization after > 3 h. Conclusions PBD was associated with neither risk of postpartum urinary retention nor excessive residual urine volume and is therefore unlikely to hamper future bladder function.

OVERACTIVE BLADDER IN CHILDREN: CLINICAL AND PARACLINAL FEATURES

Research objective. To identify clinico-laboratorial and urodynamic deviations among children with overactive bladder. Materials and methods. The study is based on examination of 20 somatically healthy children of 7-10 years old with the following complaints: sudden irresistible urges to urinate, that could be hardly restrained with or without imperative urge incontinence; frequent urination in small portions during the day; frequent awakenings during the night due to the emerging urge to urinate and involuntary urination at night. All children have been examined clinically (identification of the level of homocysteine, registration of the rhythm of urination (by keeping a diary of urination)) and through instrumental methods: uroflowmetry, ultrasound examination of the bladder with identification of the volume of residual urine, electroencephalography. Results. After the examination, the following abnormalities were identified among the majority of the patients: hyperhomocysteinemia; registration of the rhythm of urination showed that the predominant type was pollakiuria, which might be observed in frequent (more than 8 times a day) urination in small portions (among 60% of children), also enuresis (among 65%) and daytime urinary incontinence in the one third of the patients (30%) were diagnosed. On the basis of ultrasound examination of the bladder, it could be concluded that the one third of the children (33%) had an increase in the volume of residual urine (due to a decrease in the contractile function of the detrusor). By the uroflow method of research it was found out that among almost the half of the children (45%), the intermittent type of urination prevailed (in which the maximum and average urine flow rate was reduced, the time to reach the maximum speed was shortened), also rapid (30%) and non-obstructive (25%) types were diagnosed. According to the electroencephalography data, disorganization of the alpha rhythm, with a tendency to an increase in the number of beta rhythm waves was found.